Can WHO's success against neglected tropical diseases continue?

Brenda Lau, 25 Apr 2017

Neglected diseases such as dengue have historically been overlooked by the scientific community and pharmaceutical industry.

Five years after the launch of an international effort to combat the burden of tropical disease, World Health Organisation (WHO) officials said that "unprecedented progress" has been made towards reducing the spread of neglected tropical diseases that is commonly linked to poverty.

The initiative was led by the WHO and other institutions and nonprofits, most notably the Bill and Melinda Gates Foundation. Together they have worked with pharmaceutical companies to arrange large-scale donations and gathered political support for action in affected countries.

“WHO has observed record-breaking progress towards bringing ancient scourges like sleeping sickness and elephantiasis to their knees,” WHO Director-General Margaret Chan said in a statement.

“Over the past 10 years, millions of people have been rescued from disability and poverty, thanks to one of the most effective global partnerships in modern public health”.

Waning support from the US is a concern

On 18 April, supporters of the effort gathered in Geneva to commemorate five years since the signing of the London Declaration on Neglected Tropical Diseases, a commitment to rid the world of 18 neglected tropical diseases the WHO has focused on to control or eradicate.

Among the most notable achievements was the elimination of trachoma in Oman, Morocco and Mexico, as well as the near-eradication of Guinea-worm disease. In the Americas, only 25 rabies deaths were reported in 2015.

Neglected diseases have historically been overlooked by the scientific community and pharmaceutical industry. With the signed commitment, advocates believe that there is better emphasis, but at the same time are concerned that the effort can be undermined by the waning support for global health funding in Washington and elsewhere.

"We're not big enough to do this without the incredible generosity of the big governments that are far bigger than us," said Bill Gates, "Under any framework, whether it's humanitarian or strategic, maintaining these investments makes sense."

Mass drug administration programmes require funding

The battle against neglected tropical diseases began a dozen years ago. Professor David Molyneux, a tropical disease expert at the Liverpool School of Tropical Medicine, said he and some others at the WHO and in academia just decided to refocus on a number of little-known tropical diseases to raise their profile and to emphasise that in at least some cases they could be prevented at relatively low cost.

Richer countries with better sanitation and health systems could effectively eliminate neglected tropical diseases. WHO officials said more than 70% of countries and territories that report the presence of these illnesses are low-or lower-middle-income economies where inadequate hygiene and sanitation, unclean water and poor housing conditions put those in poverty at risk.

Current progress in these countries includes mass drug administration programmes where the entire population of an area is treated without first being tested for infection. These methods of preventive treatment reduce the risk of contracting the diseases for uninfected individuals.

"The problem lay in the fact that many of these diseases had unpronounceable names, didn't affect people in Western societies, [and] couldn't be transmitted in the West," Molyneux said, "Here you are with diseases that are affecting a billion-plus people, with perfectly adequate solutions available at very low cost and known to be capable of working. So we said: 'Why can't you do this?'" Molyneux said.

UK has announced more funding towards the initiative

Since then, there has been increased funding from the US and UK. On 15 April, the British government announced that it will spend £360 million on neglected tropical disease in the next half decade. Drug companies have also showed their support by donating billions of doses of drugs.

GlaxoSmithKline, Novartis and Sanofi are among major donors, WHO says. Merck said earlier it was developing a children's formula of its drug to treat schistosomiasis, a parasitic worm disease which kills 280,000 a year in Africa.

"During 2015, nearly 1 billion people — the highest number ever — received protection through preventive chemotherapy for at least one of these diseases,” Director-General Margaret Chan noted.

But like Gates and others warned, the continued success does rely greatly on continued financial assistance from the US.

“We have no idea what Congress and the new president will actually commit. … And if the commitment falls, then the number of people who are going to be treated with three drugs is going to fall proportionately,” said Molyneux. MIMS